Provider Demographics
NPI:1316051451
Name:GANDHI, SHOBHANA ANIL (MD)
Entity type:Individual
Prefix:MRS
First Name:SHOBHANA
Middle Name:ANIL
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1209
Mailing Address - Country:US
Mailing Address - Phone:323-666-7291
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-953-8821
Practice Address - Fax:323-953-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A295400Medicaid
CAU25804Medicare UPIN
CA00A295400Medicaid